Body Dysmorphic Disorder

Every now and then I see patients in my office that have no sign of baldness whatsoever, yet they are extremely concerned about losing their hair.  Some of these patients have even previously received hair transplants from other clinics.  Body Dysmorphic Disorder (BDD) or body dysmorphia is a type of mental illness in which a patient is always preoccupied with his or her appearance and cannot stop thinking about one or several problems in their face or body.  This problem may be an exaggerated preexisting problem or it may be totally imaginary.

People with BDD often have significant anxiety and do not want to be seen by anyone if possible because they think their appearance seems too shameful.   BDD could be seen in both men and women and it is estimated that 1–2% of the world’s population meet all the diagnostic criteria for body dysmorphic disorder (Psychological Medicine, vol 36, p 877).

People with BDD are intensely obsessed over their appearance and their body image, often for many hours a day or even to the point that it affects their life or work. They may ask for several cosmetic procedures in an attempt to improve their perceived image, however they are never satisfied and their perceived image cannot ever be met. If the doctor seeing this patient cannot diagnose the problem and agree to pursue with a cosmetic procedure, he or she will also tend to be blamed for some (or at times all) of the problems that they imagine they have.

Diagnosis of BDD

  1. Preoccupation with an imagined or slight defect in appearance. If a slight physical anomaly is present, the person’s concern is markedly excessive.
  2. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  3. The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa)

In research carried out by Dr. Katharine Philips, involving over 500 patients with BDD, percentages of patients concerned with the most common problem locations of their bodies were recorded and hair problems were reported in as high as 56% of patients as the second most common problem (after skin) that these patients express having.

Treatment of BDD

Treatment of body dysmorphic syndrome involves cognitive-behavior therapy which includes education about BDD and its treatment, and specific treatments to deal with faulty thoughts.  In some patients, medications may be needed as well.